Bottom Line:
These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance.To compound the problems, medications have bothersome side effects which cause the children to resist therapy.Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves.

ABSTRACTAllergic rhinitis (AR) is the most common chronic pediatric disorder. The International Study for Asthma and Allergies in Childhood phase III found that the global average of current rhinoconjunctivitis symptoms in the 13-14 year age-group was 14.6% and the average prevalence of rhinoconjunctivitis symptoms in the 6-7 year age-group was 8.5%. In addition to classical symptoms, AR is associated with a multidimensional impact on the health related quality of life in children. AR affects the quality of sleep in children and frequently leads to day-time fatigue as well as sleepiness. It is also thought to be a risk factor for sleep disordered breathing. AR results in increased school absenteeism and distraction during class hours. These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance. All these aspects upset the family too. Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, eustachian tube dysfunction and otitis media are generally associated with AR. These mostly remain undiagnosed and untreated adding to the morbidity. To compound the problems, medications have bothersome side effects which cause the children to resist therapy. Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves. AR, especially in developing countries, continues to remain a neglected disorder.

Mentions:
The ARIA update 2008 [1] classifies AR on the basis of frequency and severity. Mygind [11] first proposed classifying AR on the basis of predominant clinical symptoms. He proposed calling those with predominant blockage as 'blockers' and those with runny nose as 'sneezers and runners' [11]. We sketched the profile of these two clinical presentations in 114 adults with AR [12] and found that almost two-third 72/114 (63%) were 'sneezers and runners' while 42/114 (37%) were 'blockers'. 'Sneezers and runners' had significantly more sneezing, rhinorrhoea, itchy nose, eyes and palate. This group had a significantly more family history of atopy, seasonal disease and sensitivity to seasonal allergens like pollen. In contrast, 'blockers' had significantly more nasal blockade, thick nasal mucus, and post nasal drip. In addition, 'blockers' had significantly more sensitisation to perennial allergens like fungi and house dust mite and had perennial disease [12]. Recently, we evaluated 126 school going children with AR and/or asthma, of whom 14 (11.1%) had AR only, 100 (79.3%) had concomitant AR and asthma, while 12 (9.5%) had only asthma. On categorisation, 46 (40.4%) were classified as 'sneezers and runners' while 68 (59.6%) were classified as 'blockers'. 'Sneezers and runners' had more sneezing (100% vs. 85.3%) and itchy nose (63% vs. 54.4%), while 'blockers' had more persistent disease (52.9% vs. 32.6%), post nasal drip (67.6% vs. 54.3%), loss of smell (22.1% vs. 10.9%), loss of taste (20.6% vs. 10.9%) and nasal quality of voice (14.7% vs. 4.3%). However, the differences did not achieve significance. On CT-PNS, sinusitis (Fig. 1) was recorded in 78/126 (61.9%) children [13].

Mentions:
The ARIA update 2008 [1] classifies AR on the basis of frequency and severity. Mygind [11] first proposed classifying AR on the basis of predominant clinical symptoms. He proposed calling those with predominant blockage as 'blockers' and those with runny nose as 'sneezers and runners' [11]. We sketched the profile of these two clinical presentations in 114 adults with AR [12] and found that almost two-third 72/114 (63%) were 'sneezers and runners' while 42/114 (37%) were 'blockers'. 'Sneezers and runners' had significantly more sneezing, rhinorrhoea, itchy nose, eyes and palate. This group had a significantly more family history of atopy, seasonal disease and sensitivity to seasonal allergens like pollen. In contrast, 'blockers' had significantly more nasal blockade, thick nasal mucus, and post nasal drip. In addition, 'blockers' had significantly more sensitisation to perennial allergens like fungi and house dust mite and had perennial disease [12]. Recently, we evaluated 126 school going children with AR and/or asthma, of whom 14 (11.1%) had AR only, 100 (79.3%) had concomitant AR and asthma, while 12 (9.5%) had only asthma. On categorisation, 46 (40.4%) were classified as 'sneezers and runners' while 68 (59.6%) were classified as 'blockers'. 'Sneezers and runners' had more sneezing (100% vs. 85.3%) and itchy nose (63% vs. 54.4%), while 'blockers' had more persistent disease (52.9% vs. 32.6%), post nasal drip (67.6% vs. 54.3%), loss of smell (22.1% vs. 10.9%), loss of taste (20.6% vs. 10.9%) and nasal quality of voice (14.7% vs. 4.3%). However, the differences did not achieve significance. On CT-PNS, sinusitis (Fig. 1) was recorded in 78/126 (61.9%) children [13].

Bottom Line:
These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance.To compound the problems, medications have bothersome side effects which cause the children to resist therapy.Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves.

ABSTRACTAllergic rhinitis (AR) is the most common chronic pediatric disorder. The International Study for Asthma and Allergies in Childhood phase III found that the global average of current rhinoconjunctivitis symptoms in the 13-14 year age-group was 14.6% and the average prevalence of rhinoconjunctivitis symptoms in the 6-7 year age-group was 8.5%. In addition to classical symptoms, AR is associated with a multidimensional impact on the health related quality of life in children. AR affects the quality of sleep in children and frequently leads to day-time fatigue as well as sleepiness. It is also thought to be a risk factor for sleep disordered breathing. AR results in increased school absenteeism and distraction during class hours. These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance. All these aspects upset the family too. Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, eustachian tube dysfunction and otitis media are generally associated with AR. These mostly remain undiagnosed and untreated adding to the morbidity. To compound the problems, medications have bothersome side effects which cause the children to resist therapy. Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves. AR, especially in developing countries, continues to remain a neglected disorder.